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Join Girls Inc.
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Programs & Camps
2019/2020 Winter Break Camp
2019 Thanksgiving Break — November 25/26, 7:30 am-5:30 pm
2019 Fall Break — October 14/15, 8am-5pm
Fourth of July Parade
2019 Summer Camp
Sports
Winter/Spring 2020 Volleyball League
Volleyball 101 Beginner’s Clinic
Basketball Clinic Fall 2019
Volleyball Clinics 2019-2020
Fall 2019 Volleyball League
Girls Inc. and Cutters Soccer Clinics 2019
Events
2019 Holiday Hoopla
Strong Smart Bold Annual Luncheon
Fourth of July Parade
Girls Inc. Flower Sale and Celebration
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Girls Inc. Membership
Girls Inc. Membership
Step 1 of 5
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Participant's Information
Girl's Name
*
First
Last
Phone
Girl's Email
Girl's Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Township
Current School
*
Birthdate
*
Month
1
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12
Day
1
2
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Year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2006
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2001
2000
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Grade
Racial/Ethnic Group
*
This information helps us report information about our girls to donors and grant funders.
Select
African American
Asian American
Latina
Multiracial/Mixed Heritage
Native American
Middle Eastern or North African
White
Other
Girl's Primary Language
English
Spanish
Other
Household Information
Primary Caregiver's Name
*
First
Last
Cell Phone
*
Email
*
Other Caregiver's Name
First
Last
Cell Phone
Email
Yearly Gross Family Income
*
This information helps us report information about our girls to donors and grant funders.
Below $10,000
$10,001 to $15,000
$15,001 to $20,000
$20,001 to $25,000
$25,001 to $35,000
$35,001 to $50,000
$50,001 and above
Eligible for Free/Reduced Lunch
*
Yes
No
Eligible for TANF
*
Yes
No
I/We Will Receive Text Messages
*
This option will allow Girls Inc. to send messages about field trips and or schedule changes to you immediately. We will not send advertising messages in text.
Yes
No
Girl lives with
*
Two parents
Mother only
Father only
One parent at a time (joint custody)
Grandparent(s) or other relative(s)
Foster parent(s)
Other
Number of Family Members Living in Household
*
Safety
Emergency Contact
*
Please list an individual other than the primary caregiver.
First
Last
Emergency Contact's Relation to Girl
*
Emergency Contact's Phone
*
The following people may pick up my girl
*
Please list all possibilities. Individuals not on this list will not be able to pick up your girl without advanced notice.
Is there anyone who should NEVER pick up your girl?
*
Yes
No
Individuals who may NEVER pick up my girl
My girl is allowed to leave the premises on her own
*
Yes
No
Please explain instances when your girl may leave on her own.
Medical Information
Physician's Name
*
First
Last
Physician's Phone
*
My girl is allergic to
Please list all allergies including food and medications.
My girl takes this medication
My girl has the following special health needs
In Case of Emergency
*
I give my permission for Girls Inc. staff to secure emergency medical and non-surgical care for my minor child while participating in approved Girls Inc. activities. I also give my permission to have my child transported to the nearest emergency care facility and for hospital/emergency staff to begin any necessary procedures.
Yes
No
Photo/Video and Social Media
*
I consent to and authorize Girls Inc., or anyone authorized by Girls Inc.,to use all photographs and video of me and/or my child during this membership year (one year from this date) for any purpose, including publication, display, and exhibition in promotion without compensation to my child or me. I agree that the photographs shall constitute your sole property, with full right of disposition in any matter whatsoever. I hearby release and discharge you from any and all claims whatsoever in connection with the use of these photographs and the reproduction thereof. I understand Girls Inc. only uses first names for identification as a matter of protection and does not sell or release photos to anyone outside the organization.
Yes
No
Membership Registration
Signature of Primary Caregiver
*
I verify that I am the legal guardian of this girl. I have read the foregoing and understand its contents. I agree to read the Girls Inc. handbook available online at https://girlsinc-monroe.org/programs/membership/
Girls Inc. Membership
*
Price:
$55.00
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